Abstract WMP27: Practice Makes Perfect. Does Obtaining Nihss Certification Assure Nurse Competence And Confidence?

Abstract

Background: Competent, confident nurses are key to maintaining patient safety, promoting trust, and achieving good patient outcomes. As a Certified comprehensive stroke center, documentation of the National Institute of Health Stroke Scale (NIHSS) is required within 12 hours of admission. Nurses are required to complete an online course to be certified in the NIHSS. During rounds with neurology staff nurses, questions were raised about proficiently performing the NIHSS. The team wondered if an online certification of NIHSS assures competence and confidence performing the scale at bedside? Objective: To evaluate neurology staff nurse competence and confidence performing the NIHSS. Methods: From April 2021 to June 2021, neurology staff nurses on all shifts were randomly sampled to for an NIHSS spot check evaluation. Nurses rated their confidence, pre and post NIHSS spot check, utilizing a Likert scale from 1-5, 1=not confident, 2= somewhat confident, 3=neutral, 4=confident, 5=Very confident. The NIHSS was evaluated for competency utilizing two criteria; one point for performing the scale item correctly, and one point for scoring the item correctly, with a goal of 100% to achieve competency. Results: NIHSS spot checks significantly increased neurology staff nurses’ confidence and highlighted key areas of improvement for all participants. A total of 17 neurology staff nurses were randomly sampled from day and night shift. Average baseline confidence score was 3.8. Of those nurses, 64% increased their confidence level 1-point and 9% increased their confidence more than 1-point post evaluation. Ultimately, 100% of nurses were found to achieve competency on the NIHSS spot check. Conclusion: Neurology staff nurses were eager to be evaluated, expressing genuine interest in improving their practice. Spot checking nurses illuminated areas of improvement and provided much needed reassurance to nurses that were competent but not necessarily confident. A competent and confident nurse promotes safety and trust in their patients and assures good patient outcomes. This project demonstrated that NIHSS certification reflected competency and illustrated the value of periodically evaluating nurses 1:1 to provide re-education and promote confidence in practice.